Endotracheal tube displacement during head and neck movements. Observational clinical trial

Abstract

Study objective: Measure the displacements of endotracheal tube (ETT) tip displacement during head and neck movements.

Design: Observational study.

Setting: Ear-nose-throat (ENT) and neurosurgery operating room.

Patients: We performed a maximal head-neck movement trial on 50 adult patients, American Society of Anaesthesiologists 1 or 2. Patients with body mass index >35 kg · m(-2), height <150 cm, airway malformations, pulmonary diseases, difficulties in neck flexion or extension, previous ENT surgery or radiotherapy, gastroesophageal reflux, or dental instability were excluded from the study.

Interventions: ENT and neurosurgery.

Measurements: We measured the change in distance between the ETT tip and the carina, using a fiberscope through the ETT.

Results: After intubation, a wide disparity of tube tip distance to the carina in the neutral position was noted with a median of 5.0 (3.5-7.0) cm. Cephalad tube movement was documented following maximal head and neck extension in 34 (68%) patients and right head rotation in 25 patients (50%). Caudal tube displacement was due to maximal head and neck flexion in 38 patients (76%) and left head rotation in 25 patients (50%). Selective right main bronchus intubation was noted in 2 (4%) patients after maximal head extension.

Conclusion: Maximal head and neck movements led to unpredictable tube displacements. Proper reassessment of tube positioning after head and neck movement of intubated patients is therefore mandatory.

Keywords: Displacement; Endotracheal; Fiberscopy; Head movements.